Surgery ·
Network meta-analysis compares hemostatic devices in thyroidectomy
A network meta-analysis of 57 randomized trials compared contemporary hemostatic devices with conventional techniques in thyroid surgery. Advanced bipolar and ultrasonic devices were associated with some favorable postoperative outcomes, while ultrasonic devices also improved several measures of operative efficiency; the authors caution that rankings do not establish clinical superiority.
- Analysis included 57 randomized thyroid surgery trials.
- Advanced bipolar and ultrasonic devices reduced transient hypocalcemia.
- Ultrasonic devices improved several operative-efficiency measures.
- Rare major complications limit definitive safety comparisons.
This network meta-analysis included 57 randomized controlled trials comparing conventional hemostasis with advanced bipolar, ultrasonic, Thunderbeat and stapling devices in thyroid surgery. The primary outcome was postoperative complications; secondary outcomes included blood loss, drain volume, operative time, pain and length of stay. The researchers used a random-effects network meta-analysis and supplementary P-score rankings.
Compared with conventional hemostasis, advanced bipolar and ultrasonic devices were associated with lower odds of transient hypocalcemia (odds ratios 0.66 and 0.67, respectively) and less postoperative pain. Ultrasonic devices were associated with reduced blood loss (standardized mean difference −2.21), drain volume (mean difference −18.6 mL), operative time (−23.2 minutes) and hospital stay (−0.36 days). Advanced bipolar devices also reduced blood loss and operative time.
The authors concluded that advanced energy devices may improve operative efficiency and early postoperative outcomes, with no clear evidence of increased major complications. However, rare major complications limit definitive safety comparisons, and differences between devices were generally modest. Rankings should not be taken as proof that one device is clinically superior.
In practice
For patients undergoing thyroidectomy, the analysis suggests advanced bipolar and ultrasonic hemostatic devices may offer advantages over conventional hemostasis, including lower transient hypocalcemia and pain; ultrasonic devices were also associated with shorter operations and hospital stays. These findings may inform discussion of device options, but the analysis does not establish a clinically superior device. Differences between advanced devices were generally modest, and the trials could not definitively compare rare major complications, so the results do not support a definitive change in device choice.
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World Journal of Surgery: Comparative Effectiveness of Contemporary Hemostatic Devices in Thyroidectomy: A Network Meta‐Analysis of Surgical Safety and Operative Efficiency ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.